Healthcare Provider Details

I. General information

NPI: 1720012446
Provider Name (Legal Business Name): EILEEN M MAHONEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SALT CREEK LN STE 101
HINSDALE IL
60521-3032
US

IV. Provider business mailing address

11 SALT CREEK LN STE 101
HINSDALE IL
60521-3032
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-3110
  • Fax: 630-241-0884
Mailing address:
  • Phone: 630-789-3110
  • Fax: 630-241-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036090704
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number036090704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: